Two cross-sectional population-based surveys were conducted in 1985 and 1986 to describe cardiovascular risk factors in blacks and whites in the Twin Cities. A total of 1,254 blacks and 2,934 whites ages 35-74 years participated. The surveys consisted of a home interview followed by survey center visit during which nonfasting serum total cholesterol level was measured and medication use during the past year was reviewed. Age-adjusted mean values for serum total cholesterol were significantly higher among white than black participants for both men (207 vs 193 mg/dl, P < 0.001) and women (206 vs 202 mg/dl, P < 0.05). Blacks had significantly higher serum HDL cholesterol levels than whites (men, 49 vs 41 mg/dl, P < 0.001; women, 56 vs 54 mg/dl, P < 0.01). The age-adjusted prevalence of hypercholesterolemia (serum total cholesterol ≥240 mg/dl on the day of survey and/or current use of cholesterol lowering medication) was significantly higher among white than black men (18.3% vs 12.2%, P < 0.01). No significant race differences were noted for women (whites, 19.7% vs blacks, 16.6%). Among hypercholesterolemic men, 66% of whites and 80% of blacks were unaware of their condition; among women, 72% of whites and 79% of blacks were unaware. Among individuals told by a physician they had "high blood fats," 2.9% of whites and no blacks were using medication for elevated blood cholesterol levels, while 70% of whites and 63% of blacks reported being advised to follow a low-fat-low-cholesterol diet. These data emphasize the need for education programs for physicians and patients regarding detection and control of hypercholesterolemia.